Surgery or No Surgery for Herniated Disc?

Many of my injured clients will ask my opinion as to whether or not they should undergo a surgical procedure recommended by their orthopedic doctor.

My response always begins with the following: First, I am a personal-injury lawyer, not a doctor. The decision to have surgery is a very personal one that should be decided upon between doctors, patients and their families – not lawyers (personal injury or otherwise).

I never try to pressure my personal injury clients into having surgery. Surgery is no joke and certainly contains inherent risks. So, the questions I ask my client’s to contemplate are:

(i) Can you live with the pain?

(ii) If the pain significantly affects your quality of life, is the amount of pain so severe that you can live with the risks of surgery?

(iii) Do you want to be dependent upon pain killers (if that is the alternative)?

(iv) Have you obtained a second opinion?

2014 Dartmouth Medical School Study

The Geisel School of Medicine at Dartmouth recently published a study inSpine, a very well respected international/peer-reviewed medical journal regarding spinal disorders, comparing surgical treatment (most often an open discectomy) vs. conservative/non-surgical treatment of a lumbar-disc herniation. Over 1200 participants (average age of 41.7) came from 13 spine clinics in 11 states.

Surgical candidates had lumbar radiculopathy (radiating pain or numbness/tingling down leg) or neurological deficits (reflexes, sensory, motor) with various types of lumbar disc herniations at corresponding dermatome levels. Painful symptoms had to persist for over six weeks.

In one group, statistically significant improvements in pain and disability rating (both patient reported and doctor observed) were seen in the surgical group after one year. Those who received surgery reported better outcomes after four years, but that difference was not statistically significant.

In another group, patients who received surgery for sciatica pain reported higher rates improvement, even after eight years compared to the patients treated non-operatively. This is not to diminish the value of those who were treated more conservatively – as they reported substantial improvements as well after eight years (just not as high as the surgical group).

After eight years, there was very little evidence of harm from either treatment group. Less than 15% of those who had surgery required a second operation within eight years.

Again, I would reiterate that the decision to have surgery should not be taken lightly. Certainly, for the right candidate, surgery may offer improvement in the quality of one’s life. But, over time, conservative treatment can have good results too. The real question may be: can you live with the pain while potentially waiting years for conservative therapy to work?

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